Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes

Wong, Eugene; Smith, M. J.; Fish, Brian; Jani, Piyush; Smith, Mark C.; Riffat, Faruque

doi:10.1002/hed.25712

Cited by 6 publications

(5 citation statements)

References 28 publications

(29 reference statements)

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“…36,37 Previous studies in patients undergoing head and neck surgery support our conclusion and encourage the use of preoperative predictive models for postoperative serious complications in octogenarians. [38][39][40][41] The limitations of this study are its retrospective nature and sample size. Due to the relatively small number of complications recorded, we were limited in our ability to assess risk factors associated distinctly with each complication type.…”

Section: Discussionmentioning

confidence: 98%

Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?

Levi

Reuven

Ben-Ner

et al. 2021

Am J Rhinol�Allergy

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Background Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. Objective To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. Methods Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. Results We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. Conclusions Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.

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Section: Discussionmentioning

confidence: 98%

Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?

Levi

Reuven

Ben-Ner

et al. 2021

Am J Rhinol�Allergy

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“…Compared with other types of surgeries, e.g., benign surgery [25,26] and malignant surgery [27] in patients aged 80 years or older, thyroid surgery is considered safe [28]. However, the state of health and the preoperative comorbidities of these patients play a crucial role in the postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Mortality after benign thyroid surgery in patients aged 80 years or older

Farhad

Anders

Nordenström

et al. 2022

Langenbecks Arch Surg

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Introduction A recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80 years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register. Methods Patients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30 days, 90 days, and 1 year after surgery, for patients 80 years or older, was calculated. Overall survival was calculated using the Kaplan–Meier estimate. Risk factors for mortality were assessed with Cox’s multiple regression analysis. The standardized mortality ratio was calculated. Results There were 17,969 patients. Among them, 483 patients were 80 years or older, and of these, 397 (82.2%) were women. The mortality rate at 0–30 days, 31–90 days, and at 91–365 days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9–7.2) and the median (IQR) survival time was 8.0 (4.1–12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49–0.91) for men and 0.76 (0.65–0.89) for women. Conclusion Mortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.

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“…The data regarding the safety of total thyroidectomy in older‐adults are conflicting. Institutional series show that total thyroidectomy is safe in older‐adult (age >65) and oldest‐old (age >80) patients, with relatively low complication rates [7, 8]. Other institutional series demonstrate a significantly higher overall complication rate in oldest‐old patients (24% vs. 9%, p < 0.001) [13].…”

Section: Discussionmentioning

confidence: 99%

“…The data regarding morbidity after thyroidectomy in older‐adults (age ≥65) are conflicting. Institutional series suggest that it is a well‐tolerated procedure with minimal morbidity [7, 8]. However, several analyses of the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database have suggested that thyroidectomy in older‐adults is associated with increased risk for postoperative morbidity [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Frailty is More Predictive than Age for Complications After Thyroidectomy for Multinodular Goiter

et al. 2020

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Background Risks of thyroidectomy for multinodular goiter (MNG) in older and frail patients are unclear, particularly regarding hematoma and recurrent laryngeal nerve (RLN) palsy. Methods MNG patients undergoing total thyroidectomy were reviewed in the ACS-NSQIP procedure-targeted database (2016)(2017). Outcomes were analyzed between adult (age\65), older-adult (age C65 and\80), and oldestold (age C80) patients. Five-factor modified frailty index (mFI-5) was calculated based on functional status, diabetes, COPD, CHF, and hypertension, and used in comparative analyses. Results A total of 2189 adult, 635 older-adult, and 59 oldest-old patients were included. Compared to adult patients, older-adult and oldest-old patients had higher mFI-5 C0.4 rates (14% vs. 22% vs. 31%, respectively, p \ 0.001). The overall complication rate was 17.0% and similar between groups; however, oldest-old patients had higher rates of surgical site infection (3.4% vs. 0.3% vs. 0.4%), pneumonia (5.1% vs. 0.3% vs. 0.2%), and readmission (10.2% vs. 2.4% vs. 2.6%) compared to older-adult and adult patients, respectively (p \ 0.05). On multivariable analyses of thyroidectomy-specific complications, mFI-5 C0.4 (OR 2.5, 95%-CI 1.4-4.4) and bleeding disorder (OR 4.6, 95%-CI 1.3-16.3) were predictive of hematoma, whereas vessel-sealant device usage (OR 0.4, 95%-CI 0.3-0.7) was protective. mFI-5 C 0.4 (OR 1.5, 95%-CI 1.1-2.2), bleeding disorder (OR 2.8, 95%-CI 1.04-7.8), parathyroid autotransplantation (OR 1.7, 95%-CI 1.2-2.6), and prolonged operative time (OR 1.4, 95%-CI 1.02-1.8) were predictive of RLN palsy. Age was not a significant predictor of hematoma or RLN palsy. Conclusions Patients C80 years old are at increased risk for systemic complications and readmission after thyroidectomy for MNG. Frailty index better risk-stratifies patients than age for thyroidectomy-specific complications.

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Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes

Cited by 6 publications

References 28 publications

Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?

Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?

Mortality after benign thyroid surgery in patients aged 80 years or older

Frailty is More Predictive than Age for Complications After Thyroidectomy for Multinodular Goiter

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